Download Medication Management in the Treatment of Chronic Diseases

 Medication Management in the Treatment of Chronic Diseases Summary: Creates a program to support medication management services by local health providers. Next steps: 
Not later than May 1, 2010 – Secretary must establish this program(Note: Due to a lack of appropriations for this provision, the Agency for Health Care Research and Quality has not yet provided grants under this authority.) Additional information: 
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Agency for Healthcare Research and Quality – www.ahrq.gov American Pharmacists Association Information regarding implementation at the Agency for Healthcare Research and Quality ‐‐ http://www.pharmacist.com/AM/Template.cfm?Section=Pharmacy_News&template=/CM/
ContentDisplay.cfm&ContentID=24214 American Pharmacists Association core elements of a MTM service model ‐‐ http://www.pharmacist.com/AM/Template.cfm?Template=/CM/ContentDisplay.cfm&Cont
entID=15581 Lewin Group report on MTM services ‐‐ http://www.pharmacist.com/AM/Template.cfm?Template=/CM/ContentDisplay.cfm&Cont
entID=15581 News story regarding and article in the May/June 2010 issue of the Journal of the American Pharmacists Association showing benefit of MTM services ‐‐ http://www.healthcarefinancenews.com/press‐release/study‐reveals‐pharmacist‐
provided‐mtm‐services‐help‐improve‐patient‐health‐reduce‐medi National Council on Aging model programs for medication management ‐‐ http://www.healthyagingprograms.org/content.asp?sectionid=70 National Quality Forum – www.qualityforum.org Long summary: Sec. 3503. Medication management services in treatment of chronic disease Requires the Secretary, acting through the Patient Safety Research Center (established in section 933) at the Agency for Healthcare Research and Quality, to establish a program to support medication management services (MTM services) by local health providers. Targeted individuals. MTM services shall be offered to targeted individuals who (1) take 4 or more prescribed medications (including over‐the‐counter medications and dietary supplements); (2) take any ‘high risk’ medications; (3) have 2 or more chronic diseases, as identified by the Secretary; or (4) have undergone a transition of care, or other factors, as determined by the Secretary, that are likely to create a high risk of medication‐related problems. Consultation. In designing and implementing MTM services provided under grants or contracts awarded under subsection (a), the Secretary shall consult with Federal, State, private, public‐
private, and academic entities, pharmacy and pharmacist organizations, health care organizations, consumer advocates, chronic disease groups, and other stakeholders involved with the research, dissemination, and implementation of pharmacist‐delivered MTM services, as the Secretary determines appropriate. The Secretary, in collaboration with this group, shall determine whether it is possible to incorporate rapid cycle process improvement concepts in use in other Federal programs that have implemented MTM services. Performance measures. The Secretary may award grants or contracts to fund the development of performance measures that assess the use and effectiveness of MTM services. Legislative text: SEC. 3503. MEDICATION MANAGEMENT SERVICES IN TREATMENT OF CHRONIC DISEASE.
Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.), as amended by section 3501, is further amended
by inserting after section 934 the following:
‘‘SEC. 935. GRANTS OR CONTRACTS TO IMPLEMENT MEDICATION MANAGEMENT SERVICES IN TREATMENT OF
CHRONIC DISEASES.
‘‘(a) IN GENERAL.—The Secretary, acting through the Patient Safety Research Center established in section 933
(referred to in this section as the ‘Center’), shall establish a program to provide grants or contracts to eligible entities
to implement medication management (referred to in this section as ‘MTM’) services provided by licensed
pharmacists, as a collaborative, multidisciplinary, interprofessional approach to the treatment of chronic diseases for
targeted individuals, to improve the quality of care and reduce overall cost in the treatment of such diseases. The
Secretary shall commence the program under this section not later than May 1, 2010.
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant or contract under subsection (a), an entity shall—
‘‘(1) provide a setting appropriate for MTM services, as recommended by the experts described in subsection (e);
‘‘(2) submit to the Secretary a plan for achieving longterm financial sustainability;
‘‘(3) where applicable, submit a plan for coordinating MTM services through local community health teams
established in section 3502 of the Patient Protection and Affordable Care Act or in collaboration with primary care
extension programs established in section 399V–1;
‘‘(4) submit a plan for meeting the requirements under subsection (c); and
‘‘(5) submit to the Secretary such other information as the Secretary may require.
‘‘(c) MTM SERVICES TO TARGETED INDIVIDUALS.—The MTM services provided with the assistance of a grant or
contract awarded under subsection (a) shall, as allowed by State law including applicable collaborative pharmacy
practice agreements, include—
‘‘(1) performing or obtaining necessary assessments of the health and functional status of each patient receiving
such MTM services;
‘‘(2) formulating a medication treatment plan according to therapeutic goals agreed upon by the prescriber and the
patient or caregiver or authorized representative of the patient;
‘‘(3) selecting, initiating, modifying, recommending changes to, or administering medication therapy;
‘‘(4) monitoring, which may include access to, ordering, or performing laboratory assessments, and evaluating the
response of the patient to therapy, including safety and effectiveness;
‘‘(5) performing an initial comprehensive medication review to identify, resolve, and prevent medication-related
problems, including adverse drug events, quarterly targeted medication reviews for ongoing monitoring, and
additional followup interventions on a schedule developed collaboratively with the prescriber;
‘‘(6) documenting the care delivered and communicating essential information about such care, including a
summary of the medication review, and the recommendations of the pharmacist to other appropriate health care
providers of the patient in a timely fashion;
‘‘(7) providing education and training designed to enhance the understanding and appropriate use of the medications
by the patient, caregiver, and other authorized representative;
Page 2 ‘‘(8) providing information, support services, and resources and strategies designed to enhance patient adherence
with therapeutic regimens;
‘‘(9) coordinating and integrating MTM services within the broader health care management services provided to
the patient; and
‘‘(10) such other patient care services allowed under pharmacist scopes of practice in use in other Federal programs
that have implemented MTM services.
‘‘(d) TARGETED INDIVIDUALS.—MTM services provided by licensed pharmacists under a grant or contract awarded
under subsection (a) shall be offered to targeted individuals who—
‘‘(1) take 4 or more prescribed medications (including overthe-counter medications and dietary supplements);
‘‘(2) take any ‘high risk’ medications;
‘‘(3) have 2 or more chronic diseases, as identified by the Secretary; or
‘‘(4) have undergone a transition of care, or other factors, as determined by the Secretary, that are likely to create a
high risk of medication-related problems.
‘‘(e) CONSULTATION WITH EXPERTS.—In designing and implementing MTM services provided under grants or
contracts awarded under subsection (a), the Secretary shall consult with Federal, State, private, public-private, and
academic entities, pharmacy and pharmacist organizations, health care organizations, consumer advocates, chronic
disease groups, and other stakeholders involved with the research, dissemination, and implementation of pharmacistdelivered MTM services, as the Secretary determines appropriate. The Secretary, in collaboration with this group,
shall determine whether it is possible to incorporate rapid cycle process improvement concepts in use in other
Federal programs that have implemented MTM services. C:\TEMP\PPACA-CONSOLIDATED_003.XML HOLCPC
‘‘(f) REPORTING TO THE SECRETARY.—An entity that receives a grant or contract under subsection (a) shall submit to
the Secretary a report that describes and evaluates, as requested by the Secretary, the activities carried out under
subsection (c), including quality measures endorsed by the entity with a contract under section 1890 of the Social
Security Act, as determined by the Secretary.
‘‘(g) EVALUATION AND REPORT.—The Secretary shall submit to the relevant committees of Congress a report which
shall—
‘‘(1) assess the clinical effectiveness of pharmacist-provided services under the MTM services program, as
compared to usual care, including an evaluation of whether enrollees maintained better health with fewer
hospitalizations and emergency room visits than similar patients not enrolled in the program;
‘‘(2) assess changes in overall health care resource use by targeted individuals;
‘‘(3) assess patient and prescriber satisfaction with MTM services;
‘‘(4) assess the impact of patient-cost sharing requirements on medication adherence and recommendations for
modifications;
‘‘(5) identify and evaluate other factors that may impact clinical and economic outcomes, including demographic
characteristics, clinical characteristics, and health services use of the patient, as well as characteristics of the
regimen, pharmacy benefit, and MTM services provided; and
‘‘(6) evaluate the extent to which participating pharmacists who maintain a dispensing role have a conflict of interest
in the provision of MTM services, and if such conflict is found, provide recommendations on how such a conflict
might be appropriately addressed.
‘‘(h) GRANTS OR CONTRACTS TO FUND DEVELOPMENT OF PERFORMANCE MEASURES.—The Secretary may, through the
quality measure development program under section 931 of the Public Health Service Act, award grants or contracts
to eligible entities for the purpose of funding the development of performance measures that assess the use and
effectiveness of medication therapy management services.’’. Page 3